Impact of wait time during a first pediatric emergency room visit on likelihood of revisit in the next year

Drouin, Olivier; D’Angelo, Antonio; Gravel, Jocelyn

doi:10.1016/j.ajem.2019.07.005

Cited by 6 publications

(5 citation statements)

References 30 publications

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“…The overall satisfaction score in our study (8,3) is higher than the media reported in a systematic review by Bele et al (19) This difference could be attributed to variations in the primary care facilities or practices in the city or changes in pediatric care standards over time. The wait time for pediatric primary care (25,6 minutes) in our study is relatively shorter compared to a large cohort study by Drouin et al (20) , which reported an average wait time of 101 minutes in emergency rooms. This might be due to differences in the organization and management of primary care services and pediatric emergency rooms.…”

Section: Discussioncontrasting

confidence: 74%

Assessing Pediatric Care in Primary Health Settings: An Observational Study

Jurado

Cedeño

Gallegos

et al. 2023

Salud, Ciencia y Tecnología

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Introducción: La atención primaria pediátrica es fundamental para el diagnóstico y tratamiento precoz de los problemas de salud de los niños. Sobre el estado del tratamiento pediátrico en los establecimientos de atención primaria en el Ecuador, existen pocos datos, sin embargo.Objetivo: Examinar el estado actual de la atención pediátrica en entornos de atención primaria y señalar áreas para intervenciones enfocadas para elevar el estándar, la accesibilidad y la satisfacción de la atención pediátrica en Quito, Ecuador.Métodos: Se realizó un estudio observacional utilizando una muestra intencional de instituciones de atención primaria en Quito, Ecuador. Se utilizaron observaciones estructuradas, entrevistas con proveedores, entrevistas con padres/tutores y una revisión de registros médicos para recopilar los datos.Resultados: El estudio indicó que los establecimientos evaluados brindaron atención pediátrica de calidad variable, con un 40 % ofreciendo atención de alta calidad, un 35 % ofreciendo atención de calidad moderada y un 25 % ofreciendo atención de baja calidad. Las barreras para la atención incluyeron largos períodos de espera, escasez de proveedores de atención médica y falta de servicios especializados fácilmente accesibles. Los padres y tutores informaron una amplia gama de satisfacción del paciente: el 40% expresó gran satisfacción, el 35% expresó satisfacción moderada y el 25% expresó insatisfacción.Conclusiones: En la ciudad ecuatoriana de Quito se destacan las diferencias en la calidad, disponibilidad y satisfacción de la atención pediátrica en los entornos de atención primaria. Para superar estas dificultades y mejorar la calidad general de la atención pediátrica en el país, se requieren intervenciones específicas y modificaciones de políticas.

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Section: Discussioncontrasting

confidence: 74%

Assessing Pediatric Care in Primary Health Settings: An Observational Study

Jurado

Cedeño

Gallegos

et al. 2023

Salud, Ciencia y Tecnología

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“…Our results indicated a median waiting time from registration to the first physician visit of 27.53 minutes, which was lower than that reported in previous studies [36,37]. However, as the demand for emergency services increased, we observed prolonged waiting times during specific periods.…”

Section: Principal Findingscontrasting

confidence: 83%

Characteristics and Admission Preferences of Pediatric Emergency Patients and Their Waiting Time Prediction Using Electronic Medical Record Data: Retrospective Comparative Analysis

Guo,

et al. 2023

J Med Internet Res

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Background The growing number of patients visiting pediatric emergency departments could have a detrimental impact on the care provided to children who are triaged as needing urgent attention. Therefore, it has become essential to continuously monitor and analyze the admissions and waiting times of pediatric emergency patients. Despite the significant challenge posed by the shortage of pediatric medical resources in China’s health care system, there have been few large-scale studies conducted to analyze visits to the pediatric emergency room. Objective This study seeks to examine the characteristics and admission patterns of patients in the pediatric emergency department using electronic medical record (EMR) data. Additionally, it aims to develop and assess machine learning models for predicting waiting times for pediatric emergency department visits. Methods This retrospective analysis involved patients who were admitted to the emergency department of Children’s Hospital Capital Institute of Pediatrics from January 1, 2021, to December 31, 2021. Clinical data from these admissions were extracted from the electronic medical records, encompassing various variables of interest such as patient demographics, clinical diagnoses, and time stamps of clinical visits. These indicators were collected and compared. Furthermore, we developed and evaluated several computational models for predicting waiting times. Results In total, 183,024 eligible admissions from 127,368 pediatric patients were included. During the 12-month study period, pediatric emergency department visits were most frequent among children aged less than 5 years, accounting for 71.26% (130,423/183,024) of the total visits. Additionally, there was a higher proportion of male patients (104,147/183,024, 56.90%) compared with female patients (78,877/183,024, 43.10%). Fever (50,715/183,024, 27.71%), respiratory infection (43,269/183,024, 23.64%), celialgia (9560/183,024, 5.22%), and emesis (6898/183,024, 3.77%) were the leading causes of pediatric emergency room visits. The average daily number of admissions was 501.44, and 18.76% (34,339/183,204) of pediatric emergency department visits resulted in discharge without a prescription or further tests. The median waiting time from registration to seeing a doctor was 27.53 minutes. Prolonged waiting times were observed from April to July, coinciding with an increased number of arrivals, primarily for respiratory diseases. In terms of waiting time prediction, machine learning models, specifically random forest, LightGBM, and XGBoost, outperformed regression methods. On average, these models reduced the root-mean-square error by approximately 17.73% (8.951/50.481) and increased the R2 by approximately 29.33% (0.154/0.525). The SHAP method analysis highlighted that the features “wait.green” and “department” had the most significant influence on waiting times. Conclusions This study offers a contemporary exploration of pediatric emergency room visits, revealing significant variations in admission rates across different periods and uncovering certain admission patterns. The machine learning models, particularly ensemble methods, delivered more dependable waiting time predictions. Patient volume awaiting consultation or treatment and the triage status emerged as crucial factors contributing to prolonged waiting times. Therefore, strategies such as patient diversion to alleviate congestion in emergency departments and optimizing triage systems to reduce average waiting times remain effective approaches to enhance the quality of pediatric health care services in China.

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“…Significant decreases in the number of emergency room admissions have also been reported in other studies [ 12 , 13 ]. Reducing waiting time is often an important goal in PED reorganization and a significant metric that is monitored by health authorities [14] . The reduction in waiting time for more than half the visits was considered to be an important factor in the present study.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of changes in pediatric emergency department utilization during COVID-19 pandemic

Tuygun

Karacan

Göktüğ

et al. 2021

Archives de Pédiatrie

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Background : During the coronavirus disease 2019 (COVID-19) pandemic period, the use of emergency services with pediatric non-COVID patients has decreased considerably. We aimed to examine whether there was a change in the demographic data, triage profile, causes, management, and cost of pediatric emergency department (PED) visits of non-COVID patients during the pandemic period. Methods : This study was a retrospective, single-center, observational comparative study that was conducted at the PED. Patient records were examined during “the pandemic spring” and the same period of the previous year. Patient demographics, waiting time, and outcome of the PED visit were analyzed in the entire population of children admitted to the PED during the study period, whereas more precise data such as the reason for PED use, duration of symptoms, urgency levels according to the Emergency Severity Index (ESI), final diagnosis, management, and cost of patient care were analyzed in a sample of admitted patients. We used the chi-square test, Fisher's exact test, and Mann–Whitney U test for statistical analyses. Results : A total of 62,593 PED visits occurred. During the pandemic period, PED visits showed a decrease of 55.8% compared to the previous year. Patients included in the sampling study group were selected using a systematic random sampling method. The median waiting time during the pandemic period was significantly shorter than the previous year (median 14 min [IQR: 5–32] vs. median 5 min [IQR: 2–16]; p<0.001). The median duration of symptoms was 1 day (1–2) in both groups. Emergency Severity Index (ESI) levels I, II, and III showed a significant increase (27.7% vs. 37.3%) in triage scoring compared to levels IV and V (72.3% vs. 62.7%) during the pandemic period (p<0.001). The median cost per patient during the pandemic period was statistically higher compared to the previous year ($19.57 [19.57–40.50] vs. $25.34 [31.50–52.01]; p<0.001). Overall costs during the pandemic period had a 1.6-fold decline. Conclusion : We highlighted the changes in an ordinary PED profile during an extraordinary period. A shift in ESI levels in a more emergent direction was observed. While the number of nonurgent patients, especially those with infections, decreased, the rates of surgical cases, acute neurological and heart diseases, home accidents, and poisoning increased relative to the pre-pandemic period.

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Impact of wait time during a first pediatric emergency room visit on likelihood of revisit in the next year

Cited by 6 publications

References 30 publications

Assessing Pediatric Care in Primary Health Settings: An Observational Study

Assessing Pediatric Care in Primary Health Settings: An Observational Study

Characteristics and Admission Preferences of Pediatric Emergency Patients and Their Waiting Time Prediction Using Electronic Medical Record Data: Retrospective Comparative Analysis

Evaluation of changes in pediatric emergency department utilization during COVID-19 pandemic

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